| PART ONE: Comparison the value of pancreas ADC by using DWI in different combination of b valueObjective:to investigate the difference of apparent diffusion coefficient by using DWI with different combination of b value in normal pancreas and pancreatic nidus tissue.Method:There were totally 48 subjects of doing DWI. They were classified as three groups. One group had 16 subjects with malignant pathological changes. Another group had 16 subjects with chronic pancreatitis. The third as control group which had 16 subjects without any malignant pathological changes or chronic pancreatitis. Two types of b value of DWI were used including b=0,500,1000s/mm2 and b=50,200,400,600s/mm2. DWI with two types of b value were obtained in all samples. The ADC values were determined by comparing intra-group differences.Result:In the control group, b value at 1000 mm2 / sec , (the mean±standard deviation) ADC of (1.245±0.112)×10-3mm2/s. Its fluctuation was between (1.04～1.39)×10-3mm2/sec. While b value at 550 mm2/sec , the mean ADC o(f1.256±0.138)×10-3mm2/sec. Its fluctuation was between(0. 97～1.48)×10-3mm2/sec. Comparing the result of b value at 1000 mm2 / sec with result of b value at 550 mm2/sec, there was no statistical significance (P>0.05). but the magnitude of variance relative to mean was small.Conclusion: There were no difference of ADC value detected during undergoing DWI with b value at 1000 mm2 / sec and at 550 mm2/sec .But the higher b value was less fluctuation than the smaller one. For the smaller b value, the showing of dissection structure was more obvious which was good at showing nidus in details.PART TWO: The application of DWI in differential diagnosis of Clinical pancreatic carcinoma and pathologic typeObjective: to evaluate the ability of DWI differentiating pancreatic carcinoma and chronic pancreatitis (particularly lump type pancreatitis) from normal pancreas and to compare the difference of ADC value in different types of pancreatic carcinoma.Method:1. There were totally 84 subjects undergoing DWI. They were 21 subjects with chronic pancreatitis, 9 subjects with lump type pancreatitis, 38 subjects with pancreatic carcinoma, and 16 subjects as group control. DWI with b value = 0,500,1000mm2 /sec was used and the procedure applied was same as that in part one.2. In the group of 38 subjects with pancreatic carcinoma, The ADC values of normal pancreatic tissue and pancreatic tumor in the same patient were obtained and compared. DWI with b value = 0,500,1000mm2 /sec was obtained in this group.3. There were 28 subjects with different type of pathology of pancreatic carcinoma undergoing DWI. They were classified as 18 subjects with pancreatic ductal adenocarcinoma, 8 subjects with mucinous adenocarcinoma, one subject with anaplastic carcinoma and one subject with pancreatic adenosquamous carcinoma which was confined after biopsy done. Among 28 subjects, DWI with B value =0,500,1000mm2 /sec was applied. The measurement of ADC value was obtained in all subjects.Result: (The mean±standard deviation) ADC value of 38 subjects with pancreatic carcinoma(1.411±0.101)×10-3mm2/ses, the mean ADC value of 21 subjects with chronic pancreatitis (1.053±0.113)×10-3mm2/sec, the mean ADC value of subject with lump type pancreatitis (1.053±0.113)×10-3mm2/sec, the mean ADC value of normal pancreas (1.245±0.112)×10-3mm2/sec. It was found that there were no statistical difference between the ADC value of chronic pancreatitis and lump type pancreatitis. But the remaining groups had statistical significance (P<0.05). The ADC value of pancreatic carcinoma was the highest among other groups. The ADC value of all groups was sorted in descending order: pancreatic carcinoma, normal pancreas, chronic pancreatitis and lump type pancreatitis.Among 27 subjects with pancreatic carcinoma, The ADC value of pancreatic lump and normal pancreatic tissue were (1.402±0.094)×10-3mm2/sec and (1.112±0.116)×10-3mm2/sec respectively. Comparing by using T-test, both had statistical significance (P<0.05)Among pancreatic carcinoma, (the mean±standard deviation) ADC value of pancreatic ductal adenocarcinoma (1.402±0.094)×10-3mm2/sec, the mean ADC value of mucinous adenocarcinoma (1.584±0.127)×10-3mm2/sec. Comparatively both had statistical significance (P<0.05)Conclusion:Among pancreatic carcinoma, chronic pancreatitis (especially lump type pancreatitis) and normal pancreas, the mutual comparison of their ADC value had statistical significance. Especially for pancreatic carcinoma and chronic pancreatitis, both had clinical significance.The comparison of ADC value between pancreatic ductal adenocarcinoma and mucinous adenocarcinoma had statistical significance.PART THREE: Comparative study of the biology behavior with application of CT and DWI in pancreatic carcinomaObjective:To compare the application of CT and DWI in studying biology behavior ( surrounding internal organs, metastasis) of pancreatic carcinoma.Method: 38 subjects with pancreatic carcinoma underwent 64-row CT and DWI scanning. DWI with combination of B value = 0,500,1000s/mm2 and b=50,200,400,600s/mm2 and CT with 64 row spiral scan were obtained in all subjects. Among 38 subjects, they had 14 subjects with pancreatic carcinoma which was diffused to surrounding internal organ including 4 cases of stomach, 2 cases of left side adrenal gland, 1 case of left kidney, 6 cases of duodenum and one case of liver. Another 22 subjects with pancreatic carcinoma, their main blood vessels (superior mesenteric artery and vein) were affected. 9 out of 22 cases was superior mesenteric artery and the remaining was superior mesenteric vein. The diagnosis was confirmed by operation. For pancreatic carcinoma metastasized to liver, there were 12 subjects including 6 cases confirmation by operation and 5 cases by clinical diagnosis. pancreatic carcinoma metastasized to impress peritoneum and retina, there were 12 subjects including 8 cases confirmation by operation and 4 cases by clinical diagnosis. Result: For CT scan taken, 12 subjects with pancreatic carcinoma were found to have diffusion to surrounding internal organ including 4 cases of stomach, 2 cases of left side adrenal gland, 1 case of left kidney, 4 cases of duodenum and one case of liver. Only 2 subjects were not discovered by CT scan. For DWI taken, 14 subjects with pancreatic carcinoma were found to have diffusion to surrounding internal organ including 2 cases of stomach, 2 cases of left side adrenal gland, 1 case of left kidney, 6 cases of duodenum and one case of liver. Only 2 subjects were not discovered. For main blood vessel affecting by pancreatic carcinoma, CT scan showed 11 subjects of superior mesenteric vein (2 subjects of false negative) and 8 subjects of superior mesenteric artery while DWI showed 10 subjects of superior mesenteric vein (1 subjects of false positive) and 8 subjects of superior mesenteric artery (1 subjects of false positive). For pancreatic carcinoma metastasized to liver, CT scan found 6 subjects (6/12) which was 50% while DWI found 10 subjects (11/12) which was 91.7%.The comparison of ADC value between hepatic cyst and metastasis of liver had statistical significance(P<0.05). For the study of mestastas,DWI had its advantages with CT, Comparing by using X2-test, both had statistical significance P<0.05.Conclusion: Comparing CT with DWI on the study of biological behavior of pancreatic carcinoma, both had its advantages and disadvantages For the study of superior mesenteric artery and vein, CT scan was better than DWI at displaying blood vessels and its direction. For the image of pancreatic lump, DWI shown was more obvious. Moreover, DWI was better at showing the affected blood vessels. For the study of pancreatic carcinoma metastasis, DWI was more advantageous than CT. especially for tiny nidus. For diffusion to surrounding internal organ, Both did not have statistical significance. Therefore, for pancreatic tumor patients, the integration of CT and DWI was beneficial to discover nidus, metastasis and diffusion to surrounding organs.
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